Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a syste
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REVIEW
Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis Iulia Peciu-Florianu 1 & Jean Régis 2 & Marc Levivier 3,4 & Michaela Dedeciusova 5,6 & Nicolas Reyns 1 & Constantin Tuleasca 1,3,4,7 Received: 13 May 2020 / Revised: 31 October 2020 / Accepted: 3 November 2020 # The Author(s) 2020
Abstract Trigeminal nerve schwannomas (TS) are uncommon intracranial tumors, frequently presenting with debilitating trigeminal and/ or oculomotor nerve dysfunction. While surgical resection has been described, its morbidity and mortality rates are non-negligible. Stereotactic radiosurgery (SRS) has emerged with variable results as a valuable alternative. Here, we aimed at reviewing the medical literature on TS treated with SRS so as to investigate rates of tumor control and symptomatic improvement. We reviewed manuscripts published between January 1990 and December 2019 on PubMed. Tumor control and symptomatic improvement rates were evaluated with separate meta-analyses. This meta-analysis included 18 studies comprising a total of 564 patients. Among them, only one reported the outcomes of linear accelerators (Linac), while the others of GK. Tumor control rates after SRS were 92.3% (range 90.1–94.5; p < 0.001), and tumor decrease rates were 62.7% (range 54.3–71, p < 0.001). Tumor progression rates were 9.4% (range 6.8–11.9, p < 0.001). Clinical improvement rates of trigeminal neuralgia were 63.5% (52.9–74.1, p < 0.001) and of oculomotor nerves were 48.2% (range 36–60.5, p < 0.001). Clinical worsening rate was 10.7% (range 7.6–13.8, p < 0.001). Stereotactic radiosurgery for TS is associated with high tumor control rates and favorable clinical outcomes, especially for trigeminal neuralgia and oculomotor nerves. However, patients should be correctly advised about the risk of tumor progression and potential clinical worsening. Future clinical studies should focus on standard reporting of clinical outcomes. Keywords Trigeminal schwannoma . Radiosurgery . Gamma Knife . Trigeminal neuralgia
Introduction Trigeminal nerve schwannomas (TS) are rare, representing less than 1% of all intracranial tumors [39, 50] and 0.8 to 8% of intracranial nerve sheath tumors [10, 38]. They develop
from the sheaths of the trigeminal root, ganglion, or nerves. They usually appear at the level of Meckel’s cave, posterior fossa, or cavernous sinus and usually overlap multiple cranial fossae. Clinically, patients usually present with trigeminal nerve dysfunction, the most common symptom being
Dr Peciu-Florianu and Régis equally contributed as a first author. Dr Reyns and Tuleasca equally contributed as a senior author. * Constantin Tuleasca [email protected]; [email protected] 1
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Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
Faculty of Biology and Medicine and Centre Hospitalier Universitaire Vaudois (CHUV), Department of Clinical Neuroscience
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